A Sit Down – with Dr. Patrick Quaid

This post appears as part of my Sit Down series. Candid conversations with real people detailing their journeys and experiences with Vision Therapy.

A Sit Down – with Dr. Patrick Quaid

For the benefit of our readers, can you explain your background, as well as how you are involved in Developmental Optometry?

I was born in the Republic of Ireland and did my undergraduate degree believe it or not in medical statistics before making a switch to optometry a year and a half into the medical statistic program. I was accepted into optometry at the University of Bradford (UK) and after my four years there subsequently worked over a 2-3 year period both in the Bradford Royal Hospital and also in Moorfield’s Eye Hospital in London, UK. I mainly dealt with glaucoma and TBI at that hospital and was exposed to a lot of pathology in my years at both hospitals. I am currently involved in Developmental Optometry in that I am the sole owner of a VT only clinic in Guelph, Ontario (Canada) and I also am also the only appointed consultant optometrist to the University of Toronto Medical School (Sports Medicine). I also am an Assistant Professor at the University of Waterloo School of Optometry in addition to of course being on the Board of Directors for COVD as of this year.

What led you to this profession?

My experiences as a child to be frank. I always excelled at school but prior to about age 8-9 I was the “effortless A-grade kid” but after I sustained a head injury (MVA related) followed by a sports related concussion not too long after I developed a severe speech-impediment in addition to a significant CI which wreaked havoc with my schooling for about 3 years. I still did “ok” but worked my rear off for every single grade. My older brother in fact was the main reason I kept my head above water as he often read to me in order to help me keep grades up. If not for him I likely would not have gotten through school, I firmly believe this. Once I got my issues dealt with (SLP, OT in addition to yes….VISION THERAPY) my life did a 180 in terms of scholastics. At the time in Ireland there was not much going on in terms of VT (still not much going on) but I managed to find one optometrist who simply did Brock string work and this alone made a massive difference to me. As I went through my schooling in subsequent years that experience always stuck with me and gave me interest in rehabilitative care in general.

Is Vision Therapy taught heavily in Canadian optometry schools?

Unfortunately not. However, to be fair to Canada there is only one English-speaking school and one French-speaking school also. I think VT also in my mind is a “post-optometry” training in essence, but I do believe it certainly needs to be emphasized much more than it is in Canadian schools. I think things are slowly changing in that regard as the awareness that COVD and VT doctors overall have brought to the profession in the last 10 or so years is finally starting to pay dividends in Canada. We have seen a significant rise in the number of Canadian optometrists and vision therapist applications this year from what I have seen. I am sure the COVD examination board can confirm this. However, what is also working in our favour at present is that “routine optometry” is hurting right now with the rise of internet glasses and contact lens dispensing (as illegal as it is) and more and more revenue streams drying up for optometry. I hope that this “economic” wind will work in VT’s favour. The flip side to this of course is that vision therapy, although a great area, of course as we all know is also the easiest area to do BADLY. Therefore it is even more imperative that FCOVD and COVT certification be held out as a standard to follow.

As a result, do you find VT docs to be sparse in Canada?

Actually, no. The reason is mainly that a lot of Canadians “head south” to the USA for optometry school (more so than graduate in Canadian schools actually I think at present) and when they return with VT experience they are hungry for a like-minded clinic. I am getting many more inquiries to the Guelph Vision Therapy Center this year than last year and I think this is a positive change in that awareness of VT is clearly rising.

You opened up your private practice ‘in the backyard’ of the University of Waterloo, and although you met some resistance, is it fair to say that you seem to have made headway in their acceptance of Vision Therapy?

I think so. To be clear I am still currently an Assistant Professor at the University of Waterloo School of Optometry & Vision Science and I will always have a soft spot for UW. My mentors during my PhD and post-doctorate years there were very influential on how I grew as a researcher and clinician. Dr. Trefford Simpson for example in particular was very influential in terms of making me THINK about what results MEAN from a clinical standpoint and not just “looking for numbers”. Vision Therapy as we all know is often over-shadowed in many optometry schools by the more “sexy” pathology / TPA related areas. Concussion management however I think is slowly changing this paradigm, which in my opinion is overdue. If we have nearly 1 in 10 people out there with a binocular vision issue and only 1 in 200 over age 40 have open angle glaucoma, maybe it is high time Universities (as a whole) started practicing “evidence based teaching” and not just evidence based medicine. Is pathology important, sure…but binocular vision issues are (i) much more common and (ii) an area that optometry can “own”. In fact, if you think about it, almost every other area of eyecare “other eye-care professionals” operate in (i.e. ophthalmology and opticianry). VT is very unique to optometry and I think optometry schools need to learn this, and fast.

Why did you choose to pursue your PhD in glaucoma?

I was (and still am) very interested in how the BRAIN processes information. Many visual field tests in glaucoma (i.e. FDT for example and the Heidelberg Edge Perimeter which uses the stimulus I worked on during my PhD) use very unique stimuli to “access” certain visual pathways (i.e. dorsal or ventral). I also have an interest in how blood flow changes neuronal tissue. In essence the optic nerve (which is affected in glaucoma) is an EXTENSION of brain issue (it is in fact brain tissue). Therefore glaucoma research into brain function is a natural looking at brain functional questions (see the connection to VT?). I also managed to get a fully funded PhD at UW with essentially a full scholarship under Dr. John Flanagan, who is world-renowned in the area of glaucoma (and in fact just took up the new Dean’s position at Berkeley a position he thoroughly deserves). John was a big influence in terms of building my passion for research, but it was also very obvious to me during my PhD that although I enjoy publishing papers and still do so, my “heart” was in the clinical arena. I enjoy SEEING patients getting better and tracking the data to PROVE they are getting better. This “clinic based research” approach has allowed me to publish papers linking oculomotor dysfunction OBJECTIVELY to reading in addition to also proving that LOW blood pressure accelerates glaucomatous damage. Both findings very new in terms of “proving” the links in the research realm. To answer your question, my quest in understanding the visual system started with “why does glaucoma occur” and for me for a long time was at “what else goes wrong with the visual system and why”. Now, I am at the “aha” moment in terms of binocular vision research and I now know “how to fix it” (or at least significantly improve it) in most cases. Glaucoma started my interest in the brain, but my interest in IMPROVING how the brain functions has squarely led me to VT!

What is IRIS The Visual Group?

IRIS The Visual Group was one of the first networks I practiced with coming out of my PhD and is a network of doctor owned practices (about 165 clinics) with two ophthalmology clinics also one of which provides residency placements for laser refractive surgery co-management). I am mainly in my VT practice these days but still remain a day a week with IRIS. In my mind they are akin to the “Starbuck’s” of eyecare in Canada in that they provide a high-end environment for eyecare and eyewear but they are in essence a routine eyecare provider and not involved in VT in terms of in-office care. Over the years I have helped IRIS to build awareness within their 300+ doctor network of binocular vision dysfunction and right now as we speak a standard battery of tests (i.e. BVA at least) are being put in place to DETECT problems and refer out if needs be. The owner of the group (Dr. Francis Jean OD) unfortunately passed away last year and he was a mentor to me in terms of business. He taught me a lot about business and the importance of branding for example. The network is still going strong but over time my emphasis has shifted towards my full-time VT practice. Of course the nice thing is that we are not competing entities in that we do not dispense eyewear and IRIS does not do in-office VT. A great relationship!

Along with your appointment as a Research Professor at the University of Waterloo, you recently were appointed to the University of Toronto Medical School as a Consultant Optometrist. My understanding is that this appointment to the Toronto Medical School held some significance beyond your own personal growth. Can you explain?

In mid-2014, Dr. Doug Richards MD (Sports Medicine Director at the University of Toronto) appointed me as the only consultant optometrist to the University of Toronto in the history of UoT Sports Medicine. I was very honored to get this appointment as not only does it allow VT to be researched in more detail with medicine, it has also opened up doors for VT to be openly accepted in sports medicine in general. The University of Toronto Sports Medicine team is essentially using our Guelph VT clinic as their “go-to” site for vision related issues. There was some controversy about my appointment but the sports medicine folks have stuck to their guns and I credit them for this. They certainly recognize what VT can do and we have just completed baseline testing for over 250 athletes and have data on some of these athletes who have sustained concussion since the baseline testing (i.e. post-concussion). To say the visual data is “interesting” is an under-statement. Wait to see that research coming out in 2015/2016!

You also spent some time in the UK, I understand. What was your professional experience in that country?

I was trained in the UK. My experience of optometry in the UK was that in the hospital arena the optometrists are excellent and I would pitch them against the best of North American ODs. However, with respect to the “high street practices”, unfortunately not unlike what has happened in the USA also as of late, non-doctor corporate entities have “the rule of the roost” over there and it is a case of “20 mins exams” last time I was there. Bottom line, great optometric training on the educational side, terrible clinical environment to work in outside of the hospital system. Some great independents groups but they are getting fewer and fewer. VT is virtually non-existent there, there is BABO but they are struggling to gain acceptance from what I know.

Changing gears now, you were recently elected to COVD’s Board of Directors at the Annual Meeting in Las Vegas, NV. Why did you choose to serve COVD in this way?

I was invited to apply by Dr. David Damari (as Immediate Past President) on behalf of the board so I think that I must be doing something right. I readily accepted the invite from the board as I have always respected what COVD stands for. I have been a Fellow now for a few years and wanted more involvement with COVD as they are clearly the “thought leaders” in the VT space. I am hoping to add a “bridge” to the world of academia and the clinical world which given my history I think I am well versed to do. Not a lot of optometrists can function in both worlds at the same time, it is challenging at the best of times. However, we have to encourage clinicians to publish more and now that we have our new journal with Dr. Len Press at the helm, how can we go wrong! 😉 We have a lot of very smart people in COVD, we need to harness their brains and get more data out there on the effectiveness of VT!

How does it feel to be the “rookie” on such a great team?

I am genuinely humbled. When I see people like Barry Tannen, WC Maples, Bob Sanet, Len Press (just to name a few), I am almost wondering why I am on the board! After my PhD and post-doctorate I thought I was “done”. Lets just say my FCOVD process (excise the pun) REALLY opened my eyes to what vision care is and should be. I hope I can even fulfill 10% of what these people have done in their lifetimes and I am honored they have trusted me to be part of their team. I will certainly do my best to ensure COVD thrives.

Lastly, you have a beautiful family and a very successful practice. Have you ever had difficulty finding balance between the two?

It is always a challenge to balance work and family. This however I think is much greater a challenge for the private practitioner and certainly not a challenge I think I really appreciated when I was in full-time academia. Private practice is very rewarding but also very demanding on your time. My family is my rock, my wife (Zuhal) and my 2-year-old daughter (Ayleen) are what keep me going as they also see how happy I am doing VT. Dominick Maino always tells me that when he speaks on VT that he “loves to say that he has a colleague who is a PhD glaucoma doctor who turned to VT”. My wife will also say that I am much happier doing VT than glaucoma research. It is not that the “glaucoma research” that was bad, it was just not “me” and my family KNEW IT. Vision therapy “feels right” when I do it, and when I get a patient to thrive at school I cannot help but look at my own daughter and just KNOW that I am doing the right thing with my life. We all need to follow our passions. If the giants in my life to date (late Francis Jean of IRIS, WC Maples, Trefford Simpson) have taught me anything…..it is that life REALLY is too short to do something you are not PASSIONATE about. To me, full time research was a career, but I can safely tell you that my VT clinic is my PASSION. One day at our GVTC clinic and “feeling the high” of success with a child in vision therapy is all one needs to do to “get my point”. I consider it a privilege to do what I do and come home at night and tell my family that what I am doing genuinely changes lives. I am not sure I can get a patient excited about taking glaucoma eye-drops? A kid getting to grade level when they have always “felt stupid”, give me that any day of the week. I hope my daughter of course will follow in my footsteps, but just being a cute 2 year old is enough for now 😉

Some Closing Thoughts – A great thanks to Dr. Patrick Quaid for taking the time out for this interview! Aside from his incredible academic career, Dr. Quaid is clearly dedicated to helping both his patients and the patients of Developmental Optometry as a whole. His recent election to COVD’s board of directors serves as proof positive for his continued commitment to improving our profession. He is definitely a class act! Please join me in congratulating Dr. Quaid on his recent election to the board of directors, and in wishing both he and his lovely family the absolute best! 🙂